华西医学

华西医学

纤维支气管镜治疗卒中相关性肺炎的 meta 分析

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目的系统评价纤维支气管镜治疗卒中相关性肺炎(stroke-associated pneumonia,SAP)的效果。方法检索 Embase、PubMed、Cochrane Library、中国知网、中国生物医学文献数据库、万方数据库、维普数据库,收集纤维支气管镜治疗 SAP 的随机对照试验,检索时间为建库至 2018 年 10 月。由 2 位评价者筛选文献和提取数据,进行质量评价后采用 RevMan 5.3 软件进行 meta 分析。结果最终纳入 12 个研究,包括 1 107 例患者。meta 分析结果提示:相比于常规治疗,纤维支气管镜联合常规治疗的治疗效果更好[相对危险度(relative risk,RR)=1.26,95% 置信区间(confidence interval,CI)(1.17,1.36),P<0.000 01],住院时间更短[均数差(mean difference,MD)=–4.29 d,95%CI(–5.06,–3.52)d,P<0.000 01],临床肺部感染评分更低[MD=–1.13 分,95%CI(–1.77,–0.49)分,P=0.000 5],治疗后降钙素原[标准化均数差(standardized mean difference,SMD)=–3.86,95%CI(–4.22,–3.50),P<0.000 01]、肿瘤坏死因子 α[SMD=–2.75,95%CI(–3.84,–1.66),P<0.000 01]、C 反应蛋白[SMD=–2.55,95%CI(–3.83,–1.26),P=0.000 1]水平更低,动脉血氧分压[MD=15.34 mm Hg(1 mm Hg=0.133 kPa),95%CI(6.38,24.31)mm Hg,P=0.000 8]水平更高。结论在常规治疗基础上行纤维支气管镜治疗 SAP,能提高疗效,缩短住院时间,减轻全身炎症反应,改善通气氧合。

ObjectiveTo systematically evaluate the efficacy of fiberoptic bronchoscopy for patients with stroke-associated pneumonia (SAP).MethodsAll randomized controlled trials on fiberoptic bronchoscopy in treating SAP were collected from Embase, PubMed, Cochrane Library, China National Knowledge Infrastructure, Chinese Biology Medicine database, Wanfang database, and Chongqing VIP database. Two reviewers screened the literature, extracted data, and assessed the methodological quality of included studies. And then meta-analysis was conducted using RevMan 5.3 software.ResultsTwelve studies with 1 107 patients were included. Compared with the routine therapy, the fiberoptic bronchoscopy combined with routine therapy showed a better efficacy [relative risk (RR)=1.26, 95% confidence interval (CI) (1.17, 1.36), P<0.000 01], and indicated a shorter hospital-stay [mean difference (MD)=–4.29 days, 95%CI (–5.06, –3.52) days, P<0.000 01] and lower Clinical Pulmonary Infection Score values [MD=–1.13, 95%CI (–1.77, –0.49), P=0.000 5]. Meanwhile, a downward trend in the level of procalcitonin [standardized mean difference (SMD)=–3.86, 95%CI (–4.22, –3.50), P<0.000 01], tumor necrosis factor α [SMD=–2.75, 95%CI (–3.84, –1.66), P<0.000 01], and C-reactive protein [SMD=–2.55, 95%CI (–3.83, –1.26), P=0.000 1], as well as a higher level of partial pressure of oxygen in arterial blood [MD=15.34 mm Hg (1 mm Hg=0.133 kPa), 95%CI (6.38, 24.31) mm Hg, P=0.000 8] appeared after the combined treatment.ConclusionBased on the conventional therapy, the treatment of fiberoptic bronchoscopy can improve the efficacy, shorten the hospital stay, relieve the systemic inflammatory responses, and improve the oxygenation of SAP patients.

关键词: 纤维支气管镜; 卒中相关性肺炎; Meta 分析

Key words: Fiberoptic bronchoscopy; Stroke-associated pneumonia; Meta-analysis

引用本文: 张洋, 华天凤, 郑瑶, 李惠, 杨旻. 纤维支气管镜治疗卒中相关性肺炎的 meta 分析. 华西医学, 2019, 34(1): 66-73. doi: 10.7507/1002-0179.201901045 复制

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